Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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To date, many emergency department (ED)-based quality improvement studies and interventions for acute stroke patients have focused on expediting time-sensitive treatments, particularly reducing door-to-needle time. However, prior to treatment, a diagnosis of stroke must be reached. The ED-based stroke diagnostic process has been understudied despite its importance in assuring high-quality and safe care. ⋯ Our study results highlight the critical importance of upstream steps in the acute stroke diagnostic process, particularly the use of existing tools to identify stroke patients who may be eligible for time-sensitive treatments.
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Point-of-care ultrasound (POCUS) is a central component of emergency medical care. However, clinicians often fail to adequately document their examinations, causing problems for downstream clinicians and quality assurance processes as well as loss of revenue. The objective of this study was to evaluate the impact of a user-centered POCUS documentation workflow system for examination ordering, documentation, selective archival, and billing on POCUS documentation in a large academic emergency department (ED). ⋯ In this single-center study, POCUS documentation increased by more than 60% following the implementation of a user-centered POCUS workflow that reduced the burden on the clinician by automating data entry, improving data flow between ultrasound machines and the EHR and integrating billing.
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Review Meta Analysis
The use of dexmedetomidine in the emergency department: a systematic review.
Dexmedetomidine (DEX), a centrally acting alpha-2 agonist, is increasingly used for sedation in multiple clinical settings. Evidence from the intensive care unit and operative settings suggests DEX may have significant advantages over traditional GABAergic sedatives such as benzodiazepines. There has been limited research on the use of DEX in the emergency department (ED). ⋯ A limited body of generally poor- to moderate-quality evidence suggests that the use of DEX may be efficacious in certain clinical scenarios in the ED and that DEX use in the ED is likely safe. Further high-quality research into DEX use in the ED setting is needed, with a particular focus on clear and consistent selection of indications, identification of clear and clinically relevant primary outcomes, and careful assessment of the clinical implications of the hemodynamic effects of DEX therapy.